|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
IP
|
$3,392.03
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,374.42 |
| Max. Negotiated Rate |
$3,392.03 |
| Rate for Payer: Aetna Commercial |
$3,052.83
|
| Rate for Payer: ASR ASR |
$3,290.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,629.84
|
| Rate for Payer: BCN Commercial |
$2,629.84
|
| Rate for Payer: Cash Price |
$2,713.63
|
| Rate for Payer: Cofinity Commercial |
$3,188.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,713.62
|
| Rate for Payer: Healthscope Commercial |
$3,392.03
|
| Rate for Payer: Healthscope Whirlpool |
$3,290.27
|
| Rate for Payer: Mclaren Commercial |
$3,052.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,883.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,374.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,984.99
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$61.27
|
|
|
Service Code
|
NDC 23155-662-03
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.89 |
| Max. Negotiated Rate |
$61.27 |
| Rate for Payer: Aetna Commercial |
$55.14
|
| Rate for Payer: ASR ASR |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$47.50
|
| Rate for Payer: BCN Commercial |
$47.50
|
| Rate for Payer: Cash Price |
$49.02
|
| Rate for Payer: Cofinity Commercial |
$57.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.02
|
| Rate for Payer: Healthscope Commercial |
$61.27
|
| Rate for Payer: Healthscope Whirlpool |
$59.43
|
| Rate for Payer: Mclaren Commercial |
$55.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.92
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$101.17
|
|
|
Service Code
|
NDC 0054-0088-13
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: ASR ASR |
$98.13
|
| Rate for Payer: BCBS Trust/PPO |
$78.44
|
| Rate for Payer: BCN Commercial |
$78.44
|
| Rate for Payer: Cash Price |
$80.94
|
| Rate for Payer: Cofinity Commercial |
$95.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.94
|
| Rate for Payer: Healthscope Commercial |
$101.17
|
| Rate for Payer: Healthscope Whirlpool |
$98.13
|
| Rate for Payer: Mclaren Commercial |
$91.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.03
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$570.00
|
|
|
Service Code
|
NDC 0781-2081-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: ASR ASR |
$552.90
|
| Rate for Payer: BCBS Trust/PPO |
$441.92
|
| Rate for Payer: BCN Commercial |
$441.92
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cofinity Commercial |
$535.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.00
|
| Rate for Payer: Healthscope Commercial |
$570.00
|
| Rate for Payer: Healthscope Whirlpool |
$552.90
|
| Rate for Payer: Mclaren Commercial |
$513.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$501.60
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$507.84
|
|
|
Service Code
|
NDC 0054-0088-26
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.49 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$457.06
|
| Rate for Payer: ASR ASR |
$492.60
|
| Rate for Payer: BCBS Trust/PPO |
$393.73
|
| Rate for Payer: BCN Commercial |
$393.73
|
| Rate for Payer: Cash Price |
$406.27
|
| Rate for Payer: Cofinity Commercial |
$477.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.27
|
| Rate for Payer: Healthscope Commercial |
$507.84
|
| Rate for Payer: Healthscope Whirlpool |
$492.60
|
| Rate for Payer: Mclaren Commercial |
$457.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.90
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$565.44
|
|
|
Service Code
|
NDC 24689-793-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$395.81 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$508.90
|
| Rate for Payer: ASR ASR |
$548.48
|
| Rate for Payer: BCBS Trust/PPO |
$438.39
|
| Rate for Payer: BCN Commercial |
$438.39
|
| Rate for Payer: Cash Price |
$452.35
|
| Rate for Payer: Cofinity Commercial |
$531.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.35
|
| Rate for Payer: Healthscope Commercial |
$565.44
|
| Rate for Payer: Healthscope Whirlpool |
$548.48
|
| Rate for Payer: Mclaren Commercial |
$508.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.59
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$5.75
|
|
|
Service Code
|
NDC 68084-479-11
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna Commercial |
$5.18
|
| Rate for Payer: ASR ASR |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.46
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Healthscope Whirlpool |
$5.58
|
| Rate for Payer: Mclaren Commercial |
$5.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.06
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
NDC 57896-763-15
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: ASR ASR |
$183.33
|
| Rate for Payer: BCBS Trust/PPO |
$146.53
|
| Rate for Payer: BCN Commercial |
$146.53
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Healthscope Whirlpool |
$183.33
|
| Rate for Payer: Mclaren Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.32
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
IP
|
$577.50
|
|
|
Service Code
|
NDC 66553-004-01
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: ASR ASR |
$560.18
|
| Rate for Payer: BCBS Trust/PPO |
$447.74
|
| Rate for Payer: BCN Commercial |
$447.74
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$542.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$577.50
|
| Rate for Payer: Healthscope Whirlpool |
$560.18
|
| Rate for Payer: Mclaren Commercial |
$519.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.20
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
IP
|
$141.75
|
|
|
Service Code
|
NDC 0536-1007-15
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$127.58
|
| Rate for Payer: ASR ASR |
$137.50
|
| Rate for Payer: BCBS Trust/PPO |
$109.90
|
| Rate for Payer: BCN Commercial |
$109.90
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$133.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.40
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Healthscope Whirlpool |
$137.50
|
| Rate for Payer: Mclaren Commercial |
$127.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.74
|
|
|
CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
NDC 7985410892
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: BCBS Trust/PPO |
$254.30
|
| Rate for Payer: BCN Commercial |
$254.30
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
|
|
CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET
|
Facility
IP
|
$1.48
|
|
|
Service Code
|
NDC 5026814911
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.15
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Healthscope Whirlpool |
$1.44
|
| Rate for Payer: Mclaren Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.30
|
|
|
CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET
|
Facility
IP
|
$44.52
|
|
|
Service Code
|
NDC 5026814913
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$44.52 |
| Rate for Payer: Aetna Commercial |
$40.07
|
| Rate for Payer: ASR ASR |
$43.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.52
|
| Rate for Payer: BCN Commercial |
$34.52
|
| Rate for Payer: Cash Price |
$35.62
|
| Rate for Payer: Cofinity Commercial |
$41.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.62
|
| Rate for Payer: Healthscope Commercial |
$44.52
|
| Rate for Payer: Healthscope Whirlpool |
$43.18
|
| Rate for Payer: Mclaren Commercial |
$40.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.18
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$106.70
|
|
|
Service Code
|
NDC 3786408289
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.69 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Aetna Commercial |
$96.03
|
| Rate for Payer: ASR ASR |
$103.50
|
| Rate for Payer: BCBS Trust/PPO |
$82.72
|
| Rate for Payer: BCN Commercial |
$82.72
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cofinity Commercial |
$100.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.36
|
| Rate for Payer: Healthscope Commercial |
$106.70
|
| Rate for Payer: Healthscope Whirlpool |
$103.50
|
| Rate for Payer: Mclaren Commercial |
$96.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.90
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
NDC 1000670038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: ASR ASR |
$166.84
|
| Rate for Payer: BCBS Trust/PPO |
$133.35
|
| Rate for Payer: BCN Commercial |
$133.35
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.60
|
| Rate for Payer: Healthscope Commercial |
$172.00
|
| Rate for Payer: Healthscope Whirlpool |
$166.84
|
| Rate for Payer: Mclaren Commercial |
$154.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.36
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253-900-30
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$32.12
|
| Rate for Payer: BCBS Trust/PPO |
$25.67
|
| Rate for Payer: BCN Commercial |
$25.67
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$32.12
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$39.65
|
|
|
Service Code
|
NDC 76329-3304-1
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: ASR ASR |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$30.74
|
| Rate for Payer: BCN Commercial |
$30.74
|
| Rate for Payer: Cash Price |
$31.72
|
| Rate for Payer: Cofinity Commercial |
$37.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.72
|
| Rate for Payer: Healthscope Commercial |
$39.65
|
| Rate for Payer: Healthscope Whirlpool |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$35.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.89
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$61.10
|
|
|
Service Code
|
NDC 0409-4928-34
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$54.99
|
| Rate for Payer: ASR ASR |
$59.27
|
| Rate for Payer: BCBS Trust/PPO |
$47.37
|
| Rate for Payer: BCN Commercial |
$47.37
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$57.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$61.10
|
| Rate for Payer: Healthscope Whirlpool |
$59.27
|
| Rate for Payer: Mclaren Commercial |
$54.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.77
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253-900-36
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$32.12
|
| Rate for Payer: BCBS Trust/PPO |
$25.67
|
| Rate for Payer: BCN Commercial |
$25.67
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$32.12
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$45.21
|
|
|
Service Code
|
NDC 0409-1631-10
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$45.21 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: ASR ASR |
$43.85
|
| Rate for Payer: BCBS Trust/PPO |
$35.05
|
| Rate for Payer: BCN Commercial |
$35.05
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Cofinity Commercial |
$42.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.17
|
| Rate for Payer: Healthscope Commercial |
$45.21
|
| Rate for Payer: Healthscope Whirlpool |
$43.85
|
| Rate for Payer: Mclaren Commercial |
$40.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.78
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
IP
|
$61.10
|
|
|
Service Code
|
NDC 0409-4928-34
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$54.99
|
| Rate for Payer: ASR ASR |
$59.27
|
| Rate for Payer: BCBS Trust/PPO |
$47.37
|
| Rate for Payer: BCN Commercial |
$47.37
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$57.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$61.10
|
| Rate for Payer: Healthscope Whirlpool |
$59.27
|
| Rate for Payer: Mclaren Commercial |
$54.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.77
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
IP
|
$39.65
|
|
|
Service Code
|
NDC 76329-3304-1
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: ASR ASR |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$30.74
|
| Rate for Payer: BCN Commercial |
$30.74
|
| Rate for Payer: Cash Price |
$31.72
|
| Rate for Payer: Cofinity Commercial |
$37.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.72
|
| Rate for Payer: Healthscope Commercial |
$39.65
|
| Rate for Payer: Healthscope Whirlpool |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$35.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.89
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: ASR ASR |
$38.16
|
| Rate for Payer: BCBS Trust/PPO |
$30.50
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$39.34
|
| Rate for Payer: Healthscope Whirlpool |
$38.16
|
| Rate for Payer: Mclaren Commercial |
$35.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.62
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
IP
|
$35.38
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.77 |
| Max. Negotiated Rate |
$35.38 |
| Rate for Payer: Aetna Commercial |
$31.84
|
| Rate for Payer: ASR ASR |
$34.32
|
| Rate for Payer: BCBS Trust/PPO |
$27.43
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$35.38
|
| Rate for Payer: Healthscope Whirlpool |
$34.32
|
| Rate for Payer: Mclaren Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
IP
|
$14.85
|
|
|
Service Code
|
NDC 0536-2525-25
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Aetna Commercial |
$13.36
|
| Rate for Payer: ASR ASR |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$11.51
|
| Rate for Payer: BCN Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.88
|
| Rate for Payer: Healthscope Commercial |
$14.85
|
| Rate for Payer: Healthscope Whirlpool |
$14.40
|
| Rate for Payer: Mclaren Commercial |
$13.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.07
|
|
